Cocaine is often “cut” with various additives to increase the profitability of the drug. One of the most common additives on today’s market is levamisole, an anthelmintic medication used to destroy and expel parasitic worms in animals. The use of levamisole-contaminated cocaine can result in agranulocytosis and vasculitis (inflammation and constriction of small blood vessels). The resulting clotting and decrease in peripheral blood flow lead to cutaneous lesions, particularly on the ears, face, hands, and feet, and in severe cases can cause generalized tissue necrosis throughout the entire body. Treatment is generally supportive, and symptoms typically abate with complete cessation of cocaine use. However, symptoms may recur with subsequent cocaine use and, as this case illustrates, severe neutropenia and extensive vasculitis may lead to overwhelming sepsis and death.
Toxicology| August 01 2017
Levamisole-Adulterated Cocaine Leading to Fatal Vasculitis: A Case Report
Belinda B. Hammond, RN, MSN, CCRN;
Belinda B. Hammond is the critical care clinical nurse educator and coordinator of the new graduate Academy for Critical Care Nursing at Cone Health, Greensboro, North Carolina.
Corresponding author: Belinda B. Hammond, rn, msn, ccrn, Cone Health, 1200 N. Elm Street, Greensboro, NC 27401 (email: firstname.lastname@example.org).
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Crit Care Nurse (2017) 37 (4): 49-57.
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Belinda B. Hammond, Jordan Craven; Levamisole-Adulterated Cocaine Leading to Fatal Vasculitis: A Case Report. Crit Care Nurse 1 August 2017; 37 (4): 49–57. doi: https://doi.org/10.4037/ccn2017977
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